New Delhi: Abnormal accumulation of fat in liver beyond a certain limit is called fatty liver disease. Fatty liver disease can result from a variety of disorders beyond obesity. Historically, overwhelming majority of fatty liver disease cases were attributable to excessive alcohol consumption. Development of fatty liver was rare in people who did not drink alcohol regularly. Fatty liver disease in such patient resulted from various rare disorders and sometimes no cause was found. For convenience these patients were labeled to have non alcoholic fatty liver disease (NAFLD). Among this small group of patients with NAFLD a strong association was found with obesity, type 2 diabetes, and other metabolic abnormalities. Over the period of time incidence of obesity began to rise globally. Now majority of patients found to have fatty liver are deemed to have NAFLD.
Parag Dashatwar, Consultant Gastroenterologist, Olive Hospital, Nanal Nagar, Hyderabad, in an interview with TV9 English, answered all FAQs on the subject.
Can skinny people get fatty liver disease?
Yes, skinny people can absolutely get fatty liver disease, a condition known as lean NAFLD (Nonalcoholic Fatty Liver Disease) or non-obese NAFLD.
Unexpected link between fatty live and body type
There remains a small but significant number of patients who have a normal weight or BMI and don’t drink alcohol but still have fatty liver disease. Some estimates suggest that up to 40% of NAFLD patients are non-obese, and 10-20% are classified as “lean NAFLD.” This phenomenon is particularly prevalent in Asian populations. One of the reason for this phenomenon is that BMI does not accurately define obesity and the traditional BMI standards have been proven to be less accurate in defining obesity in South Asians. BMI takes into consideration total body weight not the component of that weight such as percentage of muscle mass or fat. South Asians on an average have higher proportion of body fat especially around belly (visceral fat) compared to other ethnicities at same body weight.
Understanding hidden causes of fatty liver disease in lean individuals
Visceral Adiposity (Internal Fat): Even if someone appears thin, they might have a high amount of visceral fat, which is fat accumulated deep within the abdomen surrounding organs like the liver. This type of fat is metabolically active and can contribute to insulin resistance and fatty liver.
Genetics: Genetic predisposition plays a significant role. Certain gene variants, like the PNPLA3 gene (rs738409 variant), are strongly linked to NAFLD development, even in lean individuals. Other genetic factors can affect lipid metabolism and increase the liver’s susceptibility to fat accumulation.
Dietary Habits: A diet high in certain components, particularly fructose and cholesterol, can contribute to fatty liver regardless of overall body weight. Excessive consumption of sugary drinks and processed foods can increase the risk.
Metabolic Abnormalities: Even without overt obesity, lean individuals with NAFLD may still exhibit metabolic abnormalities like insulin resistance, dyslipidemia (abnormal blood lipid levels), and hypertension, which contribute to the disease.
Other Causes: In some cases, specific medical conditions (like certain rare genetic disorders, malabsorption diseases or certain viral liver infections) or the use of certain medications can lead to fatty liver in lean individuals.
Important Considerations for Lean NAFLD:
Underestimation: Because lean individuals don’t present with the typical risk factor of obesity, NAFLD can be overlooked and diagnosed at a later stage, potentially leading to more advanced liver disease.
Risk of Progression: While historically considered more benign, recent research suggests that lean NAFLD can progress to more severe forms, including nonalcoholic steatohepatitis (NASH), cirrhosis, and even liver cancer. Some studies have even shown an increased risk of all-cause mortality in lean NAFLD compared to obese NAFLD, though more research is needed in this area.
Diagnosis: Diagnosis in lean individuals often requires a higher index of suspicion and may involve imaging techniques (like ultrasound, CT, or MRI) and liver function tests.
Protecting liver health: Tips for all body types
Preventing fatty liver disease largely involves adopting a healthy lifestyle. This is especially important as there only limited number of safe and effective medications to treat the condition directly, so lifestyle changes are the cornerstone of prevention and management.
Here are key tips for preventing fatty liver disease:
Maintain a Healthy Weight: Gradual Weight Loss: If you are overweight or obese, losing even a small amount of weight (3-5% of your body weight) can significantly reduce fat in the liver. Aim for a slow, steady weight loss of 0.5 to 1 kg (1-2 pounds) per week.
Calorie Control: Reduce your overall calorie intake. This is fundamental for weight loss.
Adopt a Healthy Diet: Plenty of fruits and vegetables: Aim for a wide variety, especially non-starchy vegetables. They are rich in fiber and antioxidants.
Whole grains: Choose whole-grain bread, brown rice, oats, quinoa, etc., over refined grains.
Healthy fats: Include sources like olive oil, avocados, nuts, and seeds.
Lean proteins: Opt for fish, poultry, beans, and legumes.
Limit red and processed meats: Consume these in moderation.
Reduce Added Sugars: Fructose, often found in sugary drinks (soda, fruit juice, sports drinks), candies, and processed foods, is a major contributor to liver fat. Read food labels carefully to identify hidden sugars.
Limit Refined Carbohydrates: White bread, white pasta, and other refined grains can be quickly converted to sugar and contribute to liver fat.
Minimise Saturated and Trans Fats: These unhealthy fats are found in fast food, fried foods, processed snacks, and full-fat dairy. Limit or avoid them.
Increase Fibre Intake: Foods rich in fibre (fruits, vegetables, whole grains, legumes) aid digestion, promote satiety, and help regulate blood sugar.
Consider Coffee (in moderation): Some studies suggest that moderate black coffee consumption (3-4 cups per day without sugar) may be beneficial for liver health, potentially reducing inflammation and scarring. However, if you don’t already drink coffee, it’s not a reason to start.
Include Omega-3 Fatty Acids: Found in fatty fish (salmon, mackerel, sardines) and flaxseeds, omega-3s can help reduce inflammation.
Be Physically Active
Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity (like brisk walking, cycling, or swimming) per week.
Include Strength Training: Incorporate strength exercises that work all major muscle groups at least two days a week. This helps build muscle mass, which can improve metabolism and body composition.
Start Slowly and Build Up: If you’re new to exercise, begin with shorter durations and lower intensity, gradually increasing as your fitness improves. Even 10 minutes of activity is better than none.
Limit or Avoid Alcohol: While NAFLD is “non-alcoholic,” alcohol can still exacerbate liver damage. It’s generally advisable to significantly limit or completely abstain from alcohol to protect your liver, especially if you have existing fatty liver.
Manage Underlying Health Conditions
Control Diabetes: If you have type 2 diabetes or prediabetes, work closely with your doctor to manage blood sugar levels effectively.
Lower Cholesterol and Triglycerides: Address high blood fat levels through diet, exercise, and, if necessary, medication.
Manage High Blood Pressure: Keep your blood pressure within healthy limits.
Be Cautious with Medications and Supplements:
Always consult your doctor before taking any new medications, over-the-counter drugs, or herbal supplements, as some can potentially harm the liver. By consistently implementing these lifestyle changes, you can significantly reduce your risk of developing fatty liver disease or prevent its progression if you already have it. Regular check-ups with your doctor are also important for monitoring your liver health. In summary, being skinny does not provide immunity from fatty liver disease. It’s crucial for individuals, regardless of their weight, to be aware of the risk factors and to maintain a healthy lifestyle for overall liver health.